Los Angeles County will have to win over new patients to keep its hospitals up and running as choices materialize under new federal healthcare legislation, the county’s health services director said yesterday.

Dr. Mitchell Katz presented a report to the Board of Supervisors examining the impact of the U.S. Supreme Court’s recent ruling upholding the federal Affordable Care Act.

About 80 percent of the 2.2 million people who are currently uninsured in Los Angeles County stand to gain access to affordable health care coverage, Katz told the board. About half are expected to be added to Medi-Cal rolls, while the balance will be able to purchase insurance through state-subsidized exchanges.

Katz’s report focused first on how the county’s bottom line would be affected when the new law is fully implemented in 2014.

There are lots of unknowns and several different sources of money to reimburse the county for medical services, but Katz’’s current estimate is that the county could be ahead by about $50 million as Medicaid reimbursements increase and reimbursements for those who remain uninsured decline.

Katz pointed out that the state could also pull back that money and more to balance its own budget.

But the bigger question may be whether the county can convince newly insured Angelenos to seek care at county hospitals.

“We just found out yesterday that Rancho (Los Amigos National Rehabilitation Center) once again is one of the top rehab hospitals in America,” Supervisor Don Knabe said, citing a U.S. News & World Report ranking. “But … when they have a voice, these new insured, that doesn’t necessarily mean they’re going to choose county facilities.”

Katz said he believed the most critical issue was pairing patients with a specific doctor, rather than being seen by whoever is available. The department has been working to institute that change with existing patients and 240,000 patients are now linked with to a single primary care doctor.

“You don’t necessarily have to have all of the amenities: gourmet foods, valet parking,” Katz said. “That isn’t what matters. If you look at what people say, number one is their own doctor.”

In addition, “the hospitals here, both the ones you have now and the ones you’re building, they’re high quality, beautiful,” Katz said. “We also have more board-certified physicians than almost any other group. We have good academic affiliations.’”

But Katz said the county had to overcome “the attitude of good enough” that can take hold when staff are treating patients who don’t have a choice, which can lead to long waits and poor quality care in overcrowded emergency rooms. If not, the hospitals won’t have enough patients to support their high fixed costs and portions of the system will have to shut down, he said.

While Molina, Katz and others praised county services, there will be hurdles to overcome, including potential patients’ memories of the shutdown of the former Martin Luther King Jr.-Harbor Hospital—once known as King-Drew—after federal inspectors found that inadequate care led to patient injuries and deaths.

“I think that we have to look at a strategy of how we’re going to market ourselves, how we’re going to brand ourselves because we’re going to have to compete” Supervisor Gloria Molina said.

Molina also suggested that the county look into how it could give its own employees—including Molina herself—access and incentives to use county hospitals.
Chief Executive Officer William Fujioka said preliminary discussions with county unions were already under way.